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Medically reviewed by Dr. Samuel Sarmiento, M.D., MPH on Oct. 4, 2023

A recent case report examined a unique presentation of a 38-year-old female with poorly differentiated lung SCC that had metastasized to uncommon sites.

Cancer remains a significant global health concern, with nonmelanoma skin cancer and lung cancer being among the most prevalent and commonly diagnosed types. Squamous cell carcinoma (SCC) is the second most common histological type in both skin and lung cancers. 

Challenges in Diagnosis and Treatment of Metastatic Cases

Within the field of cancer diagnosis and treatment, cases of metastasis frequently present challenges and complexities to both medical understanding and treatment strategies. 

In this case study, recently published in the journal Frontiers in Oncology, a 38-year-old woman was admitted to the hospital with a cough and dyspnea. She had a history of moderately differentiated, well-circumscribed posterior scalp SCC that was excised 8 years earlier.

Exploring Uncommon Sites of Spread

Upon examination, it was found that the patient had metastatic, poorly differentiated lung SCC with extensive involvement. The discovery of a large right lung mass with metastasis to the adrenal glands and the first rib was made. 

The uniqueness of this case included the extension of the pulmonary tumor to the left atrium via the right superior pulmonary vein. Also, an ultrasound-guided biopsy of the rib mass revealed poorly differentiated SCC, underscoring the complexity of the patient’s condition.

Diagnostic Complexities and Treatment Choices

The case presented several diagnostic challenges. The initial interpretation of the left adrenal mass reported it as an undifferentiated pleomorphic sarcoma. However, subsequent pathological examinations established it as a poorly differentiated carcinoma of lung origin. In addition, a programmed death ligand 1 (PDL1) test was used to further characterize the specimen.

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Innovative Treatment Approaches and Positive Outcomes

The patient underwent radiotherapy due to compression of the superior vena cava and mainstem bronchus. She then received a paclitaxel–carboplatin–pembrolizumab regimen as the first-line treatment for metastatic SCC. 

Monitoring her response, a follow-up echocardiogram showed a reduction in the left atrial mass, demonstrating the efficacy of the treatment approach. 

Subsequent CT scans indicated reductions in the size of lung, nodal, adrenal, and costochondral masses, along with signs of necrosis.

Role of Advanced Imaging

This case represents an uncommon presentation of a common problem that challenges the established diagnosis and treatment strategies. Ultrasound-guided interventions and medical imaging are providing valuable insights to streamline diagnosis, treatment, and follow-up. This is especially true when pathology proves inconclusive.


Clark, M., Griborio-Guzman, A. G., Burute, N. P., Lubbers, S., Anthes, M. L., Sadreddini, M., & Aseyev, O. I. (2023). When tissue is not the only issue: Poorly differentiated lung squamous-cell carcinoma with adrenal, costochondral, and cardiac metastases – case report. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1117024